Ironing out the facts about iron deficiency & anaemia

Blood iron levels

The body needs iron to produce haemoglobin – the key oxygen carrying molecule in red blood cells (RBCs). A lack of this important mineral leads to anaemia (a decrease in haemoglobin and thus a decreased production of RBCs), which reduces the body’s oxygen-carrying and delivery capabilities.

What is less well known, though, is that iron plays a critical role in the optimal function of all organs, in particular the brain, the liver and the heart. It is also a key role player in more than a 100 enzymes responsible for processes as varied as detoxification and the metabolism of medication to the production of the body’s most important energy source.

Without sufficient iron we’ll become anaemic and tired and the impact on the brain can lead to problems with concentration, forgetfulness, irritability, and even behavioural problems in young children.

Impacts mom & baby

Babies born from iron deficient mothers are often growth retarded or born prematurely, may bond poorly with the mother after birth and may have delayed growth and development and cognitive and behavioural problems that can last for up to 10 years after birth.

A mother also loses about 1000mg of iron per pregnancy, which is typically a quarter of her own iron stores. Thus it is little surprise that about 40% of pregnant women are anaemic. In half of these the cause of the anaemia is iron deficiency. More recently, a link has been suggested between iron deficiency and postnatal depression.

Rising health issue

Iron deficiency is now the most common health problem in the world with more than 2 billion people affected, while iron deficiency anaemia, affecting 1,24 billion people, is the fifth most common health problem after dental caries, latent TB (which is asymptomatic and does not need treatment), tension headaches and hearing loss.

Nevertheless, it is the leading cause of disability in low-middle socio-economic development index (SDI) countries. In South Africa, the prevalence of iron deficiency was 39,8 % in a recent study and females and black Africans had a very high prevalence of 56,6 % and 50,7 % respectively.

Signs & symptoms

Despite this, a number of misconceptions still abound. Many people, including some health professionals, think that you have to be anaemic to have symptoms or to get treatment. The reality is that patients can have iron deficiency without anaemia and still have all the symptoms of iron deficiency.

These symptoms include

  • fatigue
  • irritability
  • forgetfulness
  • poor concentration
  • cravings (especially ice or soil/clay)
  • sensitivity to cold
  • hair loss
  • nails that break easily
  • a sore tongue
  • sexual dysfunction

Most people with iron deficiency will have at least one, but often a number of these symptoms.

It is therefore critical to treat iron deficiency immediately and not wait until you become anaemic. People at risk include newborns, growing children and adolescents, menstruating females, pregnant women, those undergoing surgery, regular blood donors, endurance athletes or anyone who has some of the aforementioned symptoms.

Diagnosis is relatively simple in most patients and can be done by either a screening finger prick test for ferritin (Ferricheck®) or by sending blood to the testing laboratory. A normal fingerpick test for ferritin does not completely exclude iron deficiency, though and further laboratory tests may needed to be done in a for patients at risk and/or with symptoms. The full panel of tests include a serum iron, serum transferrin saturation, serum ferritin and haemoglobin.

Treatment action plan

If iron deficiency is confirmed, treatment is usually in the form of oral iron, taken once every second day. This new way of taking iron has been shown to be more effective, with less side-effects, when compared to taking iron daily or even twice daily. In patients who do not tolerate the oral iron or who do not show a reasonable response, intravenous iron is given.

The new, third generation intravenous irons, are generally very safe and some can be given over 15-30 minutes, which is often enough to replace all the lost iron in most people. Pregnant patients can generally still recover from iron deficiency if treated with oral iron, where they are diagnosed in the first or second trimester. These patients should not be anaemic as well. If in the second trimester and anaemic or in the third trimester, intravenous iron is often preferred to get a more assured and rapid response.

Author: Pedro van Gaalen

When he’s not writing about sport or health and fitness, Pedro is probably out training for his next marathon or ultra-marathon. He’s worked as a fitness professional and as a marketing and comms expert. He now combines his passions in his role as managing editor at Fitness magazine.

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